Healthcare Provider Details

I. General information

NPI: 1336747153
Provider Name (Legal Business Name): PATRICIA FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 ATLANTIC AVE
LONG BEACH CA
90805-6510
US

IV. Provider business mailing address

4508 ATLANTIC AVE STE A174
LONG BEACH CA
90807-1520
US

V. Phone/Fax

Practice location:
  • Phone: 562-428-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11217
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: